27 Jul Dr. Paul Hokemeyer in the Robb Report: Wealth & Addiction
Dr. Paul discusses the unique clinical needs of ultra high net worth patients in this Robb Report article:
JANUARY 01, 2015
Some surprising new weapons are in development to aid those battling addiction.
By many standards, Mark held the world in his palm. He had gone to Harvard Business School, was good-looking, with plenty of charm. By the time he was 42, he was a hedge fund manager making $15 million annually and had a wife and two children. But along with his rapid wealth and success came stress and self-doubt. To manage it, Mark began hooking up with women he met online and visiting strip clubs where he paid women for sex. He also slipped into a daily cocaine habit. After a while, the cocaine was the only thing that made him feel in control—the glue that held him together.
Until everything else fell apart. When his wife discovered a text conversation with an escort describing the cocaine used in their last encounter, she left with the kids to their vacation home. Mark, his addictions now unchecked, went on a two-day binge of sex clubs, cocaine, and martinis. When he woke up at a hotel without his wallet and keys, he realized he needed help. He checked into a 56-day treatment program at Caron Renaissance Ocean Drive, a clinical treatment center in Boca Raton, Fla., where he finally began the process of addressing his addictions.
Paul Hokemeyer, PhD, a senior clinical advisor at Ocean Drive, says that Mark’s story (his name and personal details have been changed to protect confidentiality) is typical of the patients he sees. “They have reached a point where they have an enormous amount of financial success, but the quality of their lives is in tatters,” he says. Addiction—whether to alcohol, prescription pills, or cocaine—often goes hand in hand with accomplishment. “The brain has registered that substance as the thing that enables them to succeed in the world,” Hokemeyer says.
Increasingly, scientists are uncovering the biological underpinnings of addiction. Some people are more susceptible to addiction, either because of a genetic predisposition or because of life experiences such as neglect or abuse in childhood. But addiction itself changes the brain. If someone looked inside Mark’s brain, they would see that cocaine had taken over its reward pathways, interfered with decision-making, and robbed him of his ability to make better choices.
Even people who are motivated to quit find that kicking an addiction can take months to years. But scientists are developing innovative treatments that could someday help people like Mark unravel the deep habits that keep them reaching for their next fix. One day, for instance, he could get a cocaine vaccine as part of his treatment, essentially inoculating him from its powerful high.
Vaccines are currently in development for cocaine, nicotine, heroin, and methamphetamine. “It would protect the brain from the large rush of the drug,” says Michael Owens, PhD, a pharmacologist at the University of Arkansas for Medical Sciences, of the meth vaccine he is working on.
Some of these vaccines work much like an infectious disease vaccine: An addicted patient gets a few injections of a molecule similar to the drug, attached to a foreign protein designed to rouse the immune system. The body responds by producing antibodies against the foreign substance. The next time a person takes a hit, these antibodies find and attach to the drug in the bloodstream. The antibody-bound drug molecules have a harder time crossing from the blood into the brain, keeping them from having a strong effect.
The trick is to stimulate the immune system potently. A cocaine vaccine developed by Thomas Kosten, MD, at Baylor College of Medicine is the farthest along in clinical trials. It has shown promise in keeping more people in treatment, but was only able to stimulate enough antibodies to be therapeutic in about half of the subjects. Scientists are also looking at a different kind of vaccine; rather than stimulate the body to produce antibodies, they manufacture molecules called monoclonal antibodies that attach to a specific part of the drug, which are directly infused into an addicted person. Researchers at the Scripps Research Institute in La Jolla, Calif., are developing a monoclonal antibody vaccine for cocaine, and Owens is developing one for methamphetamine. The treatment is expensive to produce, but could be more effective than a traditional vaccine. Owens says an infusion might last three or four weeks.
Like many treatments in development, a drug vaccine is not meant to be a cure for addiction. “It’s not a standalone medication. [The patient] must really be involved in some sort of behavior modification program or cognitive behavioral therapy to deal with the issues that keep them going back to the drug,” Owens says. But it could provide a crucial edge to people who are trying to change.
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